{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:12:52Z","timestamp":1789578772222,"version":"build-2803163510"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T00:00:00Z","timestamp":1762560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T00:00:00Z","timestamp":1762560000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006196","name":"University of Oulu","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The robotic approach provides fewer conversions and complications as well as better post-operative functionality in rectal surgery but increased costs in randomized trials has limited its use. The aim of this study was to compare the total hospital costs of rectal cancer surgery following the introduction of a second robotic platform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients who underwent open, laparoscopic or robotic rectal cancer resection between March 2020 and February 2023 were retrospectively collected from patient registry. Time periods represented 18 months before and 18 months after the introduction of second robotic system. Outcomes and 90-day hospital costs of 3\/2020-8\/2021 (Group1) and 9\/2021-2\/2023 (Group2) were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total cohort included 227 patients, 105 in Group1 and 122 in Group2. No significant differences were observed in ASA-class, Tumor-location, -stage or co-morbidity. Operative blood loss and operative time were similar. Increased robotic access changed the allocation of surgical modalities (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and increased the share of patients operated mini-invasively (83% vs. 93%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038), also major complications decreased (48% vs. 37%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041). Mean operative costs were higher in Group2 (13 350 vs. 12 819 \u20ac) but mean 90-d total hospital costs were lower (23 777 vs. 24 875 \u20ac, non-significant).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased robotic access changed the allocation of surgical modalities in rectal cancer surgery. Although, new robotic platform increased direct operative costs, total 90-d hospital costs did not rise due to compensatory decreases in other segments of the treatment. Therefore, increasing robotic surgery may not increase total hospital costs of rectal cancer surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11701-025-02921-1","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T07:17:04Z","timestamp":1762586224000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Increasing robotic rectal cancer surgery may not increase total hospital costs"],"prefix":"10.1007","volume":"19","author":[{"given":"Jukka","family":"Rintala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"M\u00e4kel\u00e4-Kaikkonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasi","family":"Ohtonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"M\u00e4k\u00e4r\u00e4inen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-9412","authenticated-orcid":false,"given":"Tero","family":"Rautio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,8]]},"reference":[{"issue":"3","key":"2921_CR1","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.surg.2009.03.030","volume":"146","author":"T Akiyoshi","year":"2009","unstructured":"Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y et al (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146(3):483\u2013489. https:\/\/doi.org\/10.1016\/j.surg.2009.03.030","journal-title":"Surgery"},{"issue":"2","key":"2921_CR2","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/SLA.0b013e3181b7fdb0","volume":"251","author":"T Bege","year":"2010","unstructured":"Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D et al (2010) The learning curve for the laparoscopic approach to Conservative mesorectal excision for rectal cancer: lessons drawn from a single institution\u2019s experience. Ann Surg 251(2):249\u2013253. https:\/\/doi.org\/10.1097\/SLA.0b013e3181b7fdb0","journal-title":"Ann Surg"},{"issue":"9","key":"2921_CR3","doi-asserted-by":"publisher","first-page":"2972","DOI":"10.1007\/s00464-011-1655-8","volume":"25","author":"H Kayano","year":"2011","unstructured":"Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N (2011) Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 25(9):2972\u20132979. https:\/\/doi.org\/10.1007\/s00464-011-1655-8","journal-title":"Surg Endosc"},{"key":"2921_CR4","doi-asserted-by":"crossref","unstructured":"Wang X, Cao G, Mao W, Lao W, He C (2020) Robot-assisted versus laparoscopic surgery for rectal cancer: A systematic review and meta-analysis. J Cancer Res Ther [Internet]. 16(5):979\u201389. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/33004738\/","DOI":"10.4103\/jcrt.JCRT_533_18"},{"key":"2921_CR5","doi-asserted-by":"crossref","unstructured":"Fleming CA, Cullinane C, Lynch N, Killeen S, Coffey JC, Peirce CB (2021) Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis. Br J Surg [Internet]. 108(2):128\u201337. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/33711141\/","DOI":"10.1093\/bjs\/znaa067"},{"issue":"5","key":"2921_CR6","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1007\/s11701-023-01624-9","volume":"17","author":"S Zaepfel","year":"2023","unstructured":"Zaepfel S, Marcovei R, Fernandez-de-Sevilla E, Sourrouille I, Honore C, Gelli M, Faron M, Benhaim L (2023) Robotic-assisted surgery for mid and low rectal cancer: a long but safe learning curve. J Robot Surg 17(5):2099\u20132108. https:\/\/doi.org\/10.1007\/s11701-023-01624-9. (Epub 2023 May 23. PMID: 37219783)","journal-title":"J Robot Surg"},{"key":"2921_CR7","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/codi.14502","volume":"21","author":"D Miskovic","year":"2019","unstructured":"Miskovic D, Ahmed J, Bissett-Amess R, G\u00f3mez Ruiz M, Luca F, Jayne D, Figueiredo N, Heald RJ, Spinoglio G, Parvaiz A, European Academy for Robotic Colorectal Surgery (EARCS) (2019) European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis 21:270","journal-title":"Colorectal Dis"},{"issue":"16","key":"2921_CR8","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1001\/jama.2017.7219","volume":"318","author":"D Jayne","year":"2017","unstructured":"Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J et al (2017) Effect of Robotic-Assisted vs conventional laparoscopicsurgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569\u20131580","journal-title":"JAMA"},{"issue":"1","key":"2921_CR9","doi-asserted-by":"publisher","first-page":"180","DOI":"10.3390\/cancers14010180","volume":"14","author":"K Safiejko","year":"2021","unstructured":"Safiejko K, Tarkowski R, Koselak M, Juchimiuk M, Tarasik A, Pruc M et al (2021) Robotic-Assisted vs. Standard laparoscopic surgery for rectal cancer resection: A systematic review and Meta-Analysis of 19,731 patients. Cancers (Basel) 14(1):180","journal-title":"Cancers (Basel)"},{"issue":"1","key":"2921_CR10","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12957-021-02128-2","volume":"19","author":"B Tang","year":"2021","unstructured":"Tang B, Lei X, Ai J, Huang Z, Shi J, Li T (2021) Comparison of robotic and laparoscopic rectal cancer surgery: a meta-analysis of randomized controlled trials. World J Surg Oncol 19(1):38","journal-title":"World J Surg Oncol"},{"issue":"11","key":"2921_CR11","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/S2468-1253(22)00248-5","volume":"7","author":"Q Feng","year":"2022","unstructured":"Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y, Zhang W, Zhao R, Zhang C, Cheng L, Zhang X, Liang F, He G, Wei Y, Xu J, REAL Study Group (2022) Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 7(11):991\u20131004. https:\/\/doi.org\/10.1016\/S2468-1253(22)00248-5. (Epub 2022 Sep 8. PMID: 36087608)","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2921_CR12","doi-asserted-by":"publisher","first-page":"e7585","DOI":"10.1097\/MD.0000000000007585","volume":"96","author":"X Li","year":"2017","unstructured":"Li X, Wang T, Yao L et al (2017) The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: a meta-analysis and systematic review. Med (Baltim) 96:e7585","journal-title":"Med (Baltim)"},{"key":"2921_CR13","doi-asserted-by":"publisher","unstructured":"Mar\u00eda Alejandra Guerrero-Ort\u00edz, Pellino G, Damieta MP, Gimeno M, Podda SAM Miguel Toledano, Javier N\u00fa\u00f1ez-Alfonsel, Lucio Selvaggi, Mar\u00eda Asunci\u00f3n Acosta-Merida, Juan Bellido, Benedetto Ielpo; ROBOCOSTES Collaborative Group Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES Surgery 2025:180:109134. https:\/\/doi.org\/10.1016\/j.surg.2024.109134","DOI":"10.1016\/j.surg.2024.109134"},{"key":"2921_CR14","doi-asserted-by":"crossref","unstructured":"Quijano Y, Nu\u00f1ez-Alfonsel J, Ielpo B, Ferri V, Caruso R, Dur\u00e1n H et al (2020) Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study. Tech Coloproctol [Internet]. ;24(3):247\u201354. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32020350\/","DOI":"10.1007\/s10151-020-02151-7"},{"issue":"4","key":"2921_CR15","doi-asserted-by":"publisher","first-page":"139","DOI":"10.7602\/jmis.2019.22.4.139","volume":"22","author":"Y Jeon","year":"2019","unstructured":"Jeon Y, Park EJ, Baik SHJ (2019) Robotic surgery for rectal cancer and Cost-Effectiveness. Minim Invasive Surg 22(4):139\u2013149. https:\/\/doi.org\/10.7602\/jmis.2019.22.4.139. (PMID: 35601368)","journal-title":"Minim Invasive Surg"},{"issue":"10","key":"2921_CR16","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1097\/DCR.0000000000002394","volume":"65","author":"E Gorgun","year":"2022","unstructured":"Gorgun E, Cengiz TB, Ozgur I, Dionigi B, Kalady MF, Steele SR (2022) Outcomes and cost analysis of robotic versus laparoscopic abdominoperineal resection for rectal cancer: A Case-Matched study. Dis Colon Rectum 65(10):1279\u20131286 (Epub 2021 Feb 21. PMID: 35195554)","journal-title":"Dis Colon Rectum"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02921-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-025-02921-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02921-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:11:26Z","timestamp":1781611886000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-025-02921-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,8]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2921"],"URL":"https:\/\/doi.org\/10.1007\/s11701-025-02921-1","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,8]]},"assertion":[{"value":"9 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Jukka Rintala, Johanna M\u00e4kel\u00e4-Kaikkonen and Pasi Ohtonen declare, that they have no financial interests. Author Elisa M\u00e4k\u00e4r\u00e4inen has received speaker and consultant honoraria from Medtronic. Professor Tero Rautio has received speaker and consultant honorariums from Intuitive.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Professor Tero Rautio has received speaker and consultant honorariums from Intuitive. Because of observational nature of the study, the Ethics Committees of Oulu University Hospital has confirmed that no ethical approval is required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"762"}}